How to help someone with an eating disorder

How to tell if a loved one has an eating disorder

It can be difficult to know if a loved one has an eating disorder. Particularly in the early stages, the symptoms and physical effects are not always clear. However, you may notice some signs and symptoms that cause you to become concerned and wonder if an eating disorder is present.

Symptoms may vary depending on the person and the type of eating disorder. The most common types of eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder ^[1].

Warnings signs that may indicate the presence of an eating disorder could include ^[1][2]:

• Avoiding eating with others
• Eating in secret
• Hiding or hoarding foods
• Going to the bathroom immediately after meals
• Withdrawing from social activities, particularly those that involve food
• Engaging in excessive exercise
• Checking or counting calories and fat content of food
• Regularly making negative comments about body shape or appearance
• Rituals or new behaviors around eating, such as only using specific utensils to eat, avoiding a certain type of food, or not allowing foods to touch on the plate
• Changes in mood and behavior, such as depression, agitation, anxiety, and irritability
• Complaining of stomachache
• Feeling very tired, dizzy, or faint
• Trouble concentrating
• Fluctuations in weight or extreme weight loss

How to support someone with an eating disorder

If you want to support a loved one with an eating disorder, there are several ways in which you can help them during their recovery process.

Educate yourself

First learn more about the different types of eating disorders and the symptoms and medical consequences that can occur. By educating yourself, you can be more equipped to have discussions with your loved one about their condition, know how to support them in managing their symptoms, and help to prevent them becoming severely unwell ^[3].

Similarly, learning more about eating disorders can help to reduce stigma and preconceptions that people with eating disorders commonly face. For example, it is often falsely assumed that eating disorders only affect females and are only diagnosed in people who are severely underweight. Knowing the facts can allow you to educate others and advocate for those with eating disorders ^[4].

Listen

Let your loved one tell you about their experience, rather than making assumptions about how they are feeling and behaving. By empathetically listening while your loved one explains their emotions and thoughts, you are showing them that you care. Listening also provides your loved one with an opportunity to explain how they think you could best help them and what kind of support they require ^[3][5].

Involve them

Continue trying to include your loved one in activities and events, even if they regularly decline your invitations. This demonstrates to them that they are loved and valued, which can help to improve their self-esteem and potentially prevent further social withdrawal.

Your loved one may be declining your invitations because they are afraid or unwilling to be involved in specific situations. Consider asking them what they would prefer to do while spending time with you ^[5][6].

Have realistic expectations

As is the case with anyone, someone with an eating disorder will have good days and bad days. This might mean that some days they are irritable, angry, or upset. They may relapse into unhealthy eating behaviors several times during their recovery process. Recovery can take a long time, so to remain supportive throughout you will need to be patient and understanding ^[3][5].

It is also important to note that this process can be emotionally and physically demanding for you as well, so you may wish to seek your own therapeutic support to protect your mental and physical wellbeing ^[5].

Set boundaries

While supporting your loved one in overcoming an eating disorder, you may experience them attempting to make negotiations or engaging in manipulative language or behaviors, such as ‘I will eat this if you…’ or ‘If you care about me then you won’t…’.

It can be helpful to remember that this is due to their condition, so you should remain firm while providing support and try not to engage with these behaviors, as they can be harmful for both you and them. Remind your loved one that only they are responsible for their recovery and the consequences of their actions, you are just there to support them in this process ^[3].

Protect their privacy

Be mindful of discussing your loved ones eating disorder in front of others. Try to only engage in conversations about their condition or treatment in private.

Eat together

Your loved one may find it useful to prepare and eat meals with you, so they don’t feel alone while managing the distress that can occur around mealtimes. Don’t discuss their condition at these times. Instead, try talking about other topics, listening to music, or engaging in other distractions. This can help reduce their distress and make eating feel more manageable, while modeling positive eating behaviors ^[5].

What to say to someone with an eating disorder

Learning how to communicate with someone who has an eating disorder can be crucial to providing support and demonstrating that you care about them. Try to ^[3][4][5][6]:

• Encourage them to seek professional advice: This can be a challenging step for them to take, but try giving gentle encouragement, offer to go with them, and advise them that this is the best way to overcome their eating disorder.
• Build their self-esteem: Give them compliments and positive affirmations, whether about their recovery (if this appropriate) or about their other achievements and aspects of their life. This can help show them you value and appreciate them.
• Show compassion: Eating disorders are association with a lot of stigma and negative emotions, so you could tell your loved one that you don’t think less of them, you aren’t judging them, and they don’t need to feel ashamed. This can help to reduce negative feelings they may be experiencing.
• Be open: Even though it may feel uncomfortable, have conversations around their condition. This shows you are open to talking about their experience and are available when they feel comfortable to talk. They may not want to engage in these conversations right away, but showing you are open to these discussions can help them feel supported.
• Give encouragement: You may want to discuss with your loved one what they will find helpful and unhelpful. For example, some might feel more motivated to eat if you use encouraging language during mealtimes, while for others that may be distressing and unhelpful.
• Talk about their interests: Don’t let the eating disorder become the only think you speak about with your loved one, as this could become overwhelming and frustrating. Remember that they are a person with other thoughts and interests, so try to engage with these topics.
• Help them set goals: Having a reason to get better or something to look forward to can be a motivational factor in recovery. Discuss with your loved one their goals for the future, both short-term and long-term. Celebrate when short-term goals are met and use long-term goals as reminders of why they are trying to recover.

What not to say to someone with an eating disorder

Understanding what could be unhelpful or triggering is also a useful part of supporting someone with an eating disorder, for example ^[3][5][6]:

• Don’t comment on their weight or body: Saying things like ‘You look healthy’, ‘You’ve lost/gained weight’, ‘You don’t look like you have an eating disorder’, or any other comments about their weight or appearance can be extremely distressing and triggering.
• Avoid accusatory or critical comments: Avoid being critical about their behaviors, such as ‘You never do anything with your friends’ or ‘You’re just making yourself feel worse’. Try stating facts from your own perspective, such as ‘I’m worried that you are spending a lot of time alone’, as this might be easier to accept and discuss.
• Don’t tell them what to do: Avoid saying things like ‘Just eat more/less’ and ‘Stop exercising so much’. Simplistic orders such as these don’t work, are unhelpful, and can cause feelings of guilt and frustration.
• Don’t constantly ask how they are: While it is important to check in on your loved one’s mental and physical wellbeing and offer them a space to express their feelings, it is also important not to be repetitive and overbearing with this, as it may cause damage to your relationship and prevent further conversations.

When to seek treatment

Due to the complex nature of these illnesses, eating disorders are best treated with professional support, which often involves input from a physician, mental health professional, therapist, and dietician ^[1].

It is best not to wait until your loved one is severely unwell, but to encourage them to seek treatment as early as possible. Early intervention provides the best chance of recovery from an eating disorder and can help to prevent severe or irreversible medical complications from occurring ^[1][7].

You could offer to go to appointments with your loved one to provide support. By attending appointments with your loved one, you could help them to hear and remember information that is discussed, as they may feel overwhelmed or distressed in these appointments and struggle to retain information.

Similarly, you could attend therapy with them, as family therapy has been shown to be an effective intervention for eating disorders, particularly for adolescents. Attending family therapy together can help you to gain a better understanding of your loved one’s condition and how best to support them, while also being an opportunity for you to receive support for your own wellbeing ^[7][8].